Malthaner R A, Miller J D
Division of Thoracic Surgery, University of Western Ontario, London.
Can J Surg. 2000 Oct;43(5):377-83.
To present preliminary experience with lung volume reduction surgery (LVRS) before the institution of the Canadian LVRS trial.
A prospective case series between December 1995 and January 1997.
University hospitals in London and Hamilton, Ont.
Forty-nine patients who had disabling dyspnea or emphysema with hyperinflation, able to participate in respiratory rehabilitation. Twenty-three patients were excluded because of comorbid conditions precluding surgery, pulmonary hypertension, excessive steroid dependence, malnutrition, obesity, previous thoracotomy, large solitary bullae, concurrent malignant disease, chronic bronchitis, hypercapnia or psychiatric illness.
Preoperative respiratory rehabilitation followed by LVRS via median sternotomy.
Impairment, disability and handicap were assessed before and 12 months after LVRS. Impairment was assessed by changes in pulmonary function test results and blood gas measurements, disability by the 6-minute walk test and cardiopulmonary exercise test, and handicap by the disease-specific chronic respiratory disease questionnaire (CRQ), the generic medical outcomes survey short form 36 (SF-36) and the generic health utilities index mark III (HUI-III).
Two patients died of respiratory failure while in rehabilitation. Twenty-four patients (17 men, 7 women) successfully completed rehabilitation and underwent LVRS. The mean age was 63 years (range from 49 to 78 years) and the median length of hospital stay was 12.5 days (range from 7 to 90 days). Two patients (8%) died in the early postoperative period (within 30 days) of pneumonia. One patient died of respiratory failure 8 months after LVRS after a difficult 90-day postoperative hospital stay. There were 27 major complications. There was a 36% relative increase in the mean forced expiratory volume in the first second (p = 0.01) and a 10% relative increase in the 6-minute walk test (p = 0.06). The mean CRQ dyspnea score increased 2.3 points (p = 0.01), and the SF-36 general health domain increased 20 points (p = 0.01). There was no significant change in the HUI-III (p = 0.73).
LVRS appears to lessen the respiratory impairment and handicap for at least 1 year in selected patients with advanced emphysema.
在加拿大肺减容手术试验开展之前，介绍肺减容手术（LVRS）的初步经验。
1995年12月至1997年1月的前瞻性病例系列研究。
安大略省伦敦市和汉密尔顿市的大学医院。
49例患有致残性呼吸困难或肺气肿伴肺过度充气、能够参与呼吸康复的患者。23例患者因存在妨碍手术的合并症、肺动脉高压、类固醇依赖过度、营养不良、肥胖、既往开胸手术史、巨大孤立性肺大疱、并发恶性疾病、慢性支气管炎、高碳酸血症或精神疾病而被排除。
术前进行呼吸康复，然后通过正中胸骨切开术进行肺减容手术。
在肺减容手术前及术后12个月评估损伤、残疾和残障情况。通过肺功能测试结果和血气测量的变化评估损伤，通过6分钟步行试验和心肺运动试验评估残疾，通过特定疾病的慢性呼吸系统疾病问卷（CRQ）、通用医疗结局调查简表36（SF-36）和通用健康效用指数标记III（HUI-III）评估残障。
2例患者在康复期间死于呼吸衰竭。24例患者（17例男性，7例女性）成功完成康复并接受了肺减容手术。平均年龄为63岁（范围49至78岁），中位住院时间为12.5天（范围7至90天）。2例患者（8%）在术后早期（30天内）死于肺炎。1例患者在术后艰难住院90天后，于肺减容手术8个月后死于呼吸衰竭。发生27例严重并发症。第1秒用力呼气量平均相对增加36%（p = 0.01），6分钟步行试验相对增加10%（p = 0.06）。CRQ呼吸困难平均评分增加2.3分（p = 0.01），SF-36总体健康领域评分增加20分（p = 0.01）。HUI-III无显著变化（p = 0.73）。
对于部分晚期肺气肿患者，肺减容手术似乎至少在1年内减轻了呼吸损伤和残障。
